<#include "../../select.ftl" />
<div class="row">
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">身份证号</label>

        <div class="col-sm-8">
        <#--<input name="cardno" value="${vipXxb.cardno!''}" type="text" class="form-control" onblur=funXh(this.value) />-->
        <#--<div class="input-group">-->
            <input name="cardno" value="${vipXxb.cardno!''}" type="text"
                   class="form-control"
                   onblur=funChoose(this.value) style="background-color:#C1FFC1"/>
            <input type="hidden" name="packageName2" id="packageName2" value="${vipXxb.packageName!''}"
                   class="form-control">
                                <span style="display:none" class="input-group-addon" onclick="dorefreshVip(this);"><i
                                        class="fa fa-search"></i></span>
        <#--</div>-->
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">姓名</label>

        <div class="col-sm-8">
            <input name="clientName" value="${vipXxb.clientName!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">卡别</label>

        <div class="col-sm-8">
            <input name="packageName" value="${vipXxb.packageName!''}" type="text" class="form-control"/>
        </div>
    </div>
</div>
<div class="row">
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">开始日期</label>

        <div class="col-sm-8">
            <input name="startTime" value="${vipXxb.startTime!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">结束日期</label>

        <div class="col-sm-8">
            <input name="endTime" value="${vipXxb.endTime!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">卡别金额</label>

        <div class="col-sm-8">
            <input name="packagePrice" value="${vipXxb.packagePrice!''}" type="text" class="form-control"/>
        </div>
    </div>

</div>

<div class="row">
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">会员档案号</label>

        <div class="col-sm-8">
            <input name="vipId" value="${vipXxb.vipId!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">体检卡号</label>

        <div class="col-sm-8">
            <input name="tjId" value="${vipXxb.tjId!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">门诊ID号</label>

        <div class="col-sm-8">
            <input name="mzId" value="${vipXxb.mzId!''}" type="text" class="form-control"/>
        </div>
    </div>
</div>
<div class="row">
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">入会时体检日期</label>

        <div class="col-sm-8">
            <input name="tjDate" value="${vipXxb.tjDate!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-8">
        <label class="col-sm-2 control-label">主要问题</label>

        <div class="col-sm-9">
        <#if problemList??>
            <#list problemList as problem>
                <#if vipXxb.problem??>
                    <#if vipXxb.problem?split(",")?seq_contains(problem.value)>
                        &nbsp;&nbsp;&nbsp;
                        <div class="checkbox" style="display: inline-block">
                            <input name="problem" type="checkbox" value="${problem.value}"
                                   checked="checked"><label for="opt01">${problem.content}</label>
                        </div>
                    <#else>
                        &nbsp;&nbsp;&nbsp;
                        <div class="checkbox" style="display: inline-block">
                            <input name="problem" type="checkbox" value="${problem.value}"><label
                                for="opt01">${problem.content}</label>
                        </div>
                    </#if>
                <#else>
                    &nbsp;&nbsp;&nbsp;
                    <div class="checkbox" style="display: inline-block">
                        <input name="problem" type="checkbox" value="${problem.value}"
                               id="problem"><label for="opt01">${problem.content}</label>
                    </div>
                </#if>
            </#list>
        </#if>  </div>
    </div>
</div>

<div class="row">
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">联系电话</label>

        <div class="col-sm-8">
            <input name="mobile" value="${vipXxb.mobile!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">促会医生</label>

        <div class="col-sm-8">
            <input name="promoteDoctor" value="${vipXxb.promoteDoctor!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">副会</label>

        <div class="col-sm-8">
            <input name="vice" value="${vipXxb.vice!''}" type="text" class="form-control"/>
        </div>
    </div>
</div>
<div class="row">
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">入会需求</label>

        <div class="col-sm-8">
            <input name="requirements" value="${vipXxb.requirements!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">应急联系人</label>

        <div class="col-sm-8">
            <input name="contactName" value="${vipXxb.contactName!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">应急联系电话</label>

        <div class="col-sm-8">
            <input name="contactPhone" value="${vipXxb.contactPhone!''}" type="text" class="form-control"/>
        </div>
    </div>
</div>
<div class="row">
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">适合联系时间</label>

        <div class="col-sm-8">
        <@select name="contactTime" value="${vipXxb.contactTime!''}" list=contactList class="form-control"/>
        <#--<input name="contactTime" value="${vipXxb.contactTime!''}" type="text" class="form-control"/>-->
        </div>
    </div>
    <div class="form-group col-md-8">
        <label class="col-sm-2 control-label">档案盒资料</label>

        <div class="col-sm-8">
        <#if boxList??>
            <#list boxList as box>
                <#if vipXxb.box??>
                    <#if vipXxb.box?split(",")?seq_contains(box.value)>
                        <div class="checkbox" style="display: inline-block">
                            <input name="box" type="checkbox" value="${box.value}"
                                   checked="checked"><label for="opt01">${box.content}</label>
                        </div>
                    <#else>
                        <div class="checkbox" style="display: inline-block">
                            <input name="box" type="checkbox" value="${box.value}"><label
                                for="opt01">${box.content}</label>
                        </div>
                    </#if>
                <#else>
                    <div class="checkbox" style="display: inline-block">
                        <input name="box" type="checkbox" value="${box.value}"
                               id="box"><label for="opt01">${box.content}</label>
                    </div>
                </#if>
            </#list>
        </#if>
        <#--<input name="box" value="${vipXxb.box!''}" type="text" class="form-control"/>-->
        </div>
    </div>
</div>

<div class="row">
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">入会时用药</label>

        <div class="col-sm-8">
            <input name="medication" value="${vipXxb.medication!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">入会时药量</label>

        <div class="col-sm-8">
        <@select name="drug" value="${vipXxb.drug!''}" list=dosageList class="form-control"/>
        <#--<input name="drug" value="${vipXxb.drug!''}" type="text" class="form-control"/>-->
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">入会时主观感受</label>

        <div class="col-sm-8">
        <@select name="feel" value="${vipXxb.feel!''}" list=feelList class="form-control"/>
        <#--<input name="feel" value="${vipXxb.feel!''}" type="text" class="form-control"/>-->
        </div>
    </div>
</div>
<div class="row">
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">地址所属区域</label>

        <div class="col-sm-8">
            <input name="address" value="${vipXxb.address!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">详细地址</label>

        <div class="col-sm-8">
            <input name="detailedAddress" value="${vipXxb.detailedAddress!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">备注</label>

        <div class="col-sm-8">
            <input name="note" value="${vipXxb.note!''}" type="text" class="form-control"/>
        </div>
    </div>
</div>
<div class="row">
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">分管人</label>

        <div class="col-sm-8">
            <input name="fgrDoctor" value="${vipXxb.fgrDoctor!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">最近见面时间</label>

        <div class="col-sm-8">
            <input name="meetTime" value="${vipXxb.meetTime!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">最近联系时间及方式</label>

        <div class="col-sm-8">
        <@select name="meetType" value="${vipXxb.meetType!''}" list=interventionList class="form-control"/>
        <#--<input name="meetType" value="${vipXxb.meetType!''}" type="text" class="form-control"/>-->
        </div>
    </div>
</div>
<div class="row">
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">首次入会日期</label>

        <div class="col-sm-8">
            <input name="firstTime" value="${vipXxb.firstTime!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">应上门次数</label>

        <div class="col-sm-8">
            <input name="zgDoor" value="${vipXxb.zgDoor!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">余上门次数</label>

        <div class="col-sm-8">
            <input name="syDoor" value="${vipXxb.syDoor!''}" type="text" class="form-control"/>
        </div>

    </div>
</div>
<div class="row">
<#--<div class="form-group col-md-4">-->
<#--<label class="col-sm-4 control-label">性别</label>-->

<#--<div class="col-sm-8">-->
<#--<@select name="asgender" value="${vipXxb.asgender!''}" list=sexList class="form-control"/>-->
<#--&lt;#&ndash;<input name="asgender" value="${vipXxb.asgender!''}" type="text" class="form-control"/>&ndash;&gt;-->
<#--</div>-->
<#--</div>-->

    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">是否过期</label>

        <div class="col-sm-8">
        <@select name="obligateA" value="${vipXxb.obligateA!''}" list=sfgqList class="form-control"/>
            <#--<input name="obligateA" value="${vipXxb.obligateA!''}" type="text" class="form-control"/>-->
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">配合度</label>

        <div class="col-sm-8">
        <@select name="cooperationDegree" value="${vipXxb.cooperationDegree!''}" list=coopeateList class="form-control"/>
        <#--<input name="cooperationDegree" value="${vipXxb.cooperationDegree!''}" type="text" class="form-control"/>-->
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">最后一次体检日期</label>

        <div class="col-sm-8">
            <input name="lastDate" value="${vipXxb.lastDate!''}" type="text" class="form-control"/>
        </div>
    </div>
</div>
<div class="row">
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">会员续会概率</label>

        <div class="col-sm-8">
        <@select name="probability" value="${vipXxb.probability!''}" list=vipList class="form-control"/>
        <#--<input name="probability" value="${vipXxb.probability!''}" type="text" class="form-control"/>-->
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">可能转卡类</label>

        <div class="col-sm-8">
        <@select name="turnCard" value="${vipXxb.turnCard!''}" list=cardList class="form-control"/>
  <#--<input name="turnCard" value="${vipXxb.turnCard!''}" type="text" class="form-control"/>-->
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">管理后药量</label>

        <div class="col-sm-8">
        <@select name="dosage" value="${vipXxb.dosage!''}" list=dosageList class="form-control"/>
        <#--<input name="dosage" value="${vipXxb.dosage!''}" type="text" class="form-control"/>-->
        </div>
    </div>
</div>
<div class="row">
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">管理后主观感受</label>

        <div class="col-sm-8">
        <@select name="afterFeeling" value="${vipXxb.afterFeeling!''}" list=feelList class="form-control"/>
        <#--<input name="afterFeeling" value="${vipXxb.afterFeeling!''}" type="text" class="form-control"/>-->
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">会员转接记录</label>

        <div class="col-sm-8">
            <input name="transferRecord" value="${vipXxb.transferRecord!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">转接注意事项</label>

        <div class="col-sm-8">
            <input name="transferAttention" value="${vipXxb.transferAttention!''}" type="text" class="form-control"/>
        </div>
    </div>
</div>
<div style="display:none;" class="row">
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">希和客户ID</label>

        <div class="col-sm-8">
            <input name="clientNo" value="${vipXxb.clientNo!''}" type="text" class="form-control"/>
        </div>
    </div>
    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">阿米巴客户ID</label>

        <div class="col-sm-8">
            <input name="ambId" value="${vipXxb.ambId!''}" type="text" class="form-control"/>
        </div>
    </div>


    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">入会时体检预约号</label>

        <div class="col-sm-8">
            <input name="firstReport" value="${vipXxb.firstReport!''}" type="text" class="form-control"/>
        </div>
    </div>

    <div class="form-group col-md-4">
        <label class="col-sm-4 control-label">管理期最后一次体检预约号</label>

        <div class="col-sm-8">
            <input name="lastReport" value="${vipXxb.lastReport!''}" type="text" class="form-control"/>
        </div>

        <div class="form-group col-md-4" style="style=" display:none
        ;">
        <label class="col-sm-4 control-label"></label>

        <div class="col-sm-8">
            <input name="obligateB" value="${vipXxb.obligateB!''}" type="text" class="form-control"/>
        </div>
    </div>
</div>
<#--<div class="form-group col-md-4">
    <label class="col-sm-4 control-label"></label>

    <div class="col-sm-8">
        <input name="obligateA" value="${vipXxb.obligateA!''}" type="text" class="form-control"/>
    </div>
</div>

<div class="form-group col-md-4">
    <label class="col-sm-4 control-label"></label>

    <div class="col-sm-8">
        <input name="obligateC" value="${vipXxb.obligateC!''}" type="text" class="form-control"/>
    </div>
</div>-->
<div class="form-group col-md-4" style="display:none">
    <label class="col-sm-4 control-label"></label>

    <div class="col-sm-8">
        <input name="obligateD" value="${vipXxb.obligateD!''}" type="text" class="form-control"/>
    </div>
</div>
<#--<div class="form-group col-md-4">
    <label class="col-sm-4 control-label"></label>

    <div class="col-sm-8">
        <input name="creatTime" value="${vipXxb.creatTime!''}" type="text" class="form-control"/>
    </div>
</div>
<div class="form-group col-md-4">
    <label class="col-sm-4 control-label"></label>

    <div class="col-sm-8">
        <input name="creatName" value="${vipXxb.creatName!''}" type="text" class="form-control"/>
    </div>
</div>-->
</div>